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Femoral head fractures

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The femoral head is fed by three arteries, the main one of which is the medial femoral circumflex. If this is disrupted, there is a high risk of avascular necrosis.

Classification

The standard classification of femoral head fractures is that of Pipkin

The key criterion in the Pipkin classification is whether the femoral head is fracture fractured above or below the fovea. A type 1 fracture is with the fracture

  • Type 1 - femoral head fracture below the fovea

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  • Type 2 - femoral head fracture above the fovea
  • Type 3 - femoral head fracture (regardless of location) associated with a femoral neck fracture

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  • Type 4 - femoral head fracture associated with an acetabular fracture.

(authorAuthor's note: as argued elsewhere a better classification system would match up to correlate with treatment requirements. A BMSD modification of Pipkin would be: type Type 1 : - head fracture with concentric reduction and no fragments; type Type 2 : - head fracture with either fragments or lack of reduction; type Type 3 : - head fracture with femoral neck or acetabular fractures, the presence of which demands priority treatment.)

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Head fractures classified as Pipkin types 1 and Pipkin 2 with concentric reduction and no loose fragments in the joint can be treated non-operatively. These criteria can be determined with CT scans.

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Does resection of fragments lead to instability?

Outcomes

References